Unveiling the Spatial Pattern and Determinants of Child Anaemia in India - National Family Health Survey-5 Chronicles (NFHS-5)

  • Abhijeet Joshi Associate Professor,Department of Anatomy, Government Medical College, Barmer, Rajasthan.
  • Deepak Tanwar Assistant Professor, Department of Community Medicine, Government Medical College, Barmer, Rajasthan
  • Pawan Kumar Dubey Associate- Monitoring & Evaluation, India Health Action Trust, Lucknow, Uttar Pradesh.
  • Mukesh Vishwakarma Banasthali Vidyapith
  • Sabrina Sultana Rahman Research Scholar, Department of Statistics, Cotton University, Assam
Keywords: Childhood anaemia, Logistic regression, LISA, Spatial error model

Abstract


Background/Aim: Childhood anaemia continues to persist as a prominent nutritional disease and a public health challenge in India despite several initiatives by the Government of India. This study aimed to identify predictors and regional disparities for targeted interventions.

Methods: This study utilised data from a nationally representative cross-sectional survey from the fifth round of the National Family Health Survey (NFHS-5), encompassing 177,695 children aged 6-59 months across 707 districts and 36 states and union territories of India. It employed multivariate logistic regression and spatial analysis at district levels to examine socio-demographic predictors and spatial patterns of childhood anaemia in the country.

Result: Multivariate logistic results revealed, women aged 15–19 were 2.43 times more likely to have an anaemic child compared to those aged 35–49 and uneducated mothers had a 29 % higher likelihood of having an anaemic child. There was positive spatial autocorrelation (Moran’s I value = 0.579) at the district level in India, with 108 identified hotspots in regions including Jammu and Kashmir, Ladakh, Gujarat, Maharashtra, Telangana, Uttar Pradesh, Rajasthan, Jharkhand, Chhattisgarh and Bihar. The spatial error model (SEM) indicated that mother's anaemia (0.53) and maternal education (0.23) were key predictors of child anaemia in India.

Conclusion: The study findings provide valuable understanding regarding the socio-demographic predictors associated with childhood anaemia such as adolescent motherhood, low education, lack of media exposure, higher birth order and rural residence. Also, the spatial study provides the spatial heterogeneity of childhood anaemia at the district level and advocates more attention toward hotspot regions in the country.

References

Kapil U, Kapil R, Gupta A. National Iron Plus Initiative: current status & future strategy. The Indian journal of medical research. 2019 Sep;150(3):239. doi: 10.4103/ijmr.ijmr_1782_18.

Habte D, Asrat K, Magafu MG, Ali IM, Benti T, Abtew W, et al. Maternal risk factors for childhood anaemia in Ethiopia. Afr J Reproduc Health. 2013 Sep 1;17(3):110-8. PMID: 24069773.

World Health Organization. Anemia. [Internet]. [Cited: 1 Jan 2023]. Available at: https://www.who.int/health-topics/anaemia.

Anand T, Rahi M, Sharma P, Ingle GK. Issues in prevention of iron deficiency anemia in India. Nutrition. 2014 Jul 1;30(7-8):764-70. doi: 10.1016/j.nut.2013.11.022.

Thankachan P, Walczyk T, Muthayya S, Kurpad AV, Hurrell RF. Iron absorption in young Indian women: the interaction of iron status with the influence of tea and ascorbic acid. Am J Clin Nutr. 2008 Apr;87(4):881-6. doi: 10.1093/ajcn/87.4.881.

Calis JC, Phiri KS, Faragher EB, Brabin BJ, Bates I, Cuevas LE, et al. Severe anemia in Malawian children. N Engl J Med. 2008 Feb 28;358(9):888-99. doi: 10.1056/NEJMoa072727.

Schneider JM, Fujii ML, Lamp CL, Lönnerdal B, Dewey KG, Zidenberg-Cherr S. Anemia, iron deficiency, and iron deficiency anemia in 12-36-mo-old children from low-income families. Am J Clin Nutr. 2005 Dec;82(6):1269-75. doi: 10.1093/ajcn/82.6.1269.

International Institute for Population Sciences (IIPS) and ICF, 2021. National Family Health Survey (NFHS-5), 2019–21: India. [Internet]. [Cited: 1 Jan 2023]. Available at: https://main.mohfw.gov.in/sites/default/files/NFHS-5_Phase-II_0.pdf.

Kalaivani K, Ramachandran P. Time trends in prevalence of anaemia in pregnancy. Indian J Med Res. 2018 Mar;147(3):268-77. doi: 10.4103/ijmr.IJMR_1730_16.

Subramaniam G, Girish M. Iron deficiency anemia in children. Indian J Pediatr. 2015 Jun;82:558-64. doi: 10.1007/s12098-014-1643-9.

Sekhar DL, Murray-Kolb LE, Kunselman AR, Weisman CS, Paul IM. Association between menarche and iron deficiency in non-anemic young women. PloS One. 2017 May 9;12(5):e0177183. doi: 10.1371/journal.pone.0177183.

Bentley ME, Griffiths PL. The burden of anemia among women in India. Eur J Clin Nutr. 2003 Jan;57(1):52-60. doi: 10.1038/sj.ejcn.1601504.

Kedar PS, Harigae H, Ito E, Muramatsu H, Kojima S, Okuno Y, et al. Study of pathophysiology and molecular characterization of congenital anemia in India using targeted next-generation sequencing approach. Int J Hematol. 2019 Nov;110:618-26. doi: 10.1007/s12185-019-02716-9.

Anselin L. Thirty years of spatial econometrics. Pap Reg Sci. 2010 Mar;89(1):3-25. doi: 10.1111/j.1435-5957.2010.00279.x

Getis A, Ord JK. The analysis of spatial association by use of distance statistics. Geogr Anal. 1992 Jul;24(3):189-206. doi: 10.1111/j.1538-4632.1992.tb00261.x.

Getis A, Ord JK, Anselin L, Rey SJ. Perspectives on spatial data analysis. Berlin, Germany: Springer; 2010. doi: 10.1007/978-3-642-01976-0.

Anselin L. Local indicators of spatial association—LISA. Geogr Anal. 1995 Apr;27(2):93-115. doi: 10.1111/j.1538-4632.1995.tb00338.x

Clark PJ, Evans FC. Distance to nearest neighbour as a measure of spatial relationships in populations. Ecology. 1954 Oct 1;35(4):445-53. doi: 10.2307/1931034.

Cliff AD, Ord K. Spatial autocorrelation: a review of existing and new measures with applications. Econ Geogr. 1970 Jun 1;46(sup1):269-92. doi: 10.2307/143144.

Anselin L. Spatial regression. The SAGE handbook of spatial analysis. California, USA: SAGE Publications, Ltd 2009;1:255-76. doi: 10.4135/9780857020130.

Pasricha SR, Black J, Muthayya S, Shet A, Bhat V, Nagaraj S, et al. Determinants of anemia among young children in rural India. Pediatrics. 2010 Jul 1;126(1):e140-9. doi: 10.1542/peds.2009-3108.

Wharton BA. Iron deficiency in children: detection and prevention. Br J Haematol. 1999 Aug;106(2):270-80. doi: 10.1046/j.1365-2141.1999.01511.x.

Chen K, Zhang X, Li TY, Chen L, Qu P, Liu YX. Co-assessment of iron, vitamin A and growth status to investigate anemia in preschool children in suburb Chongqing, China. World J Pediatr. 2009 Nov;5:275-81. doi: 10.1007/s12519-009-0052-z.

Skalicky A, Meyers AF, Adams WG, Yang Z, Cook JT, Frank DA. Child food insecurity and iron deficiency anemia in low-income infants and toddlers in the United States. Matern Child Health J. 2006 Mar;10(2):177-85. doi: 10.1007/s10995-005-0036-0.

Rutstein SO, Kiersten J. The DHS Wealth Index. Calverton, Maryland. Report; 2004. doi: 10.13140/2.1.2806.4809.

Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013 Aug 3;382(9890):452-77. doi: 10.1016/S0140-6736(13)60996-4.

Sharma H, Singh SK, Srivastava S. Socio-economic inequality and spatial heterogeneity in anaemia among children in India: Evidence from NFHS-4 (2015–16). Clin Epidemiol Glob Health. 2020 Dec 1;8(4):1158-71. doi: 10.1016/j.cegh.2020.04.009.

Mehrotra M, Yadav S, Deshpande A, Mehrotra H. A study of the prevalence of anemia and associated sociodemographic factors in pregnant women in Port Blair, Andaman and Nicobar Islands. J Family Med Prim Care. 2018 Nov-Dec;7(6):1288-93. doi: 10.4103/jfmpc.jfmpc_139_18.

Ngesa O, Mwambi H. Prevalence and risk factors of anaemia among children aged between 6 months and 14 years in Kenya. PLoS One. 2014 Nov 25;9(11):e113756. doi: 10.1371/journal.pone.0113756.

Desai S, Alva S. Maternal education and child health: Is there a strong causal relationship?. Demography. 1998 Feb 1;35(1):71-81. PMID: 9512911.

Paul S, Paul S, Gupta AK, James KS. Maternal education, health care system and child health: Evidence from India. Soc Sci Med. 2022 Mar;296:114740. doi: 10.1016/j.socscimed.2022.11474.

Kumar P, Chauhan S, Patel R, Srivastava S. Anaemia among mother-father-child pairs in India: examining co-existence of triple burden of anaemia in a family. BMC Public Health. 2021 Dec;21(1):1-8. doi: 10.1186/s12889-021-11408-1.

Ghosh K, Desai GS. Prevalence and detecting spatial clustering of anaemia among children 6–59 months in the districts of India. Clin Epidemiol Glob Health. 2021 Oct 1;12:100845. doi: 10.1016/j.cegh.2021.100845

Anteneh ZA, Van Geertruyden JP. Spatial variations and determinants of anemia among under-five children in Ethiopia, EDHS 2005–2016. Plos One. 2021 Apr 1;16(4):e0249412. doi: 10.1371/journal.pone.0249412.

Melku M, Alene KA, Terefe B, Enawgaw B, Biadgo B, Abebe M, et al. Anemia severity among children aged 6–59 months in Gondar town, Ethiopia: a community-based cross-sectional study. Ital J Pediatr. 2018 Sep 3;44(1):107. doi: 10.1186/s13052-018-0547-0.

Gebremeskel MG, Tirore LL. Factors associated with anemia among children 6–23 months of age in Ethiopia: a multilevel analysis of data from the 2016 Ethiopia demographic and health survey. Pediatric Health Med Ther. 2020 Sep 16;11:347-57. doi: 10.2147/PHMT.S258114.

Simieneh MM, Mengistu MY, Gelagay AA, Gebeyehu MT. Mothers' health care seeking behavior and associated factors for common childhood illnesses, Northwest Ethiopia: community based cross-sectional study. BMC Health Serv Res. 2019 Jan 23;19(1):59. doi: 10.1186/s12913-019-3897-4.

Published
2024/04/18
Section
Original article